Grim infant and maternal mortality rates have been regularly cited as evidence of Afghanistan's backwardness after decades of war, and of the slow progress of the internationally funded reconstruction effort.

According to the preliminary results of a Johns Hopkins University study, the infant mortality rate has declined to about 135 per 1,000 live births in 2006, from an estimated 165 per 1,000 in 2001.

The researchers "found improvements in virtually all aspects of care in almost every province," the Public Health Ministry and World Bank said Thursday in a joint statement on the findings.

"Despite many challenges, there are clear signs of health sector recovery and progress throughout the country," said Public Health Minister Mohammad Amin Fatimi. "But there is a long way to go to provide access to basic health services for Afghans in far remote, underserved and marginalized areas across the country."

Benjamin P. Loevinsohn, a World Bank health specialist, said the survey results probably underestimated the improvement in infant mortality.

"It's a conservative estimate. This is the situation two-and-a-half to three years ago ... It should be better than that now," Loevinsohn said.

He said children were benefiting from a push in 2004 to improve health care and access to vaccinations for diseases such as measles, polio and tetanus.

The researchers studied more than 600 health facilities annually since 2004.

Doctors and health professionals visited 8,278 households, using a standardized questionnaire to interview one mother per household about her birth history. The study found the number of women receiving prenatal care increased to 30 percent in 2006 from 5 percent in 2003.

Nineteen percent of pregnant women were attended by a skilled health worker last year, up from only 5 percent in 2003.

The survey was conducted in 29 of the country's 34 provinces - excluding Helmand, Uruzgan, Kandahar, Zabul and Nuristan because of security concerns, Loevinsohn said.

The ministry is working to set up small clinics, deploy mobile teams in remote rural areas, expand community midwifery training, and increase the number of female staff at health facilities.

Afghanistan still has one of the world's highest maternal mortality rates. One in 60 Afghan women dies of pregnancy-related causes, said U.N. Population Fund executive director Thoraya Ahmed Obaid.

"No woman should die giving life," Obaid said during a visit to Afghanistan this week. "No nation can be developed when its women are dying giving birth."

Obaid encouraged Afghan women to leave several years between the birth of each child to reduce the risk to themselves.

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